There is no one-size-fits-all approach to the evaluation process when cognitive impairment is detected. Some primary care teams are prepared to conduct a diagnostic evaluation for dementia while others may need to develop their diagnostic processes and/or refer to others. The approaches and tools presented here are intended to provide information and options that will help care teams formulate new procedures or appraise and perhaps improve the team’s existing diagnostic procedures for dementia. If the primary care team is unable to conduct a diagnostic evaluation, then patients with suspected cognitive impairment should be referred to a clinician or team of specialists with expertise in dementia (e.g., geriatrician, neurologist, geriatric psychiatrist, neuropsychologist, nurse practitioner with geropsychiatric expertise, memory disorders clinic) (GSA, 2015).

If cognitive impairment is detected, at a minimum, reversible physiological causes of cognitive impairment need to be ruled out (GSA, 2015). The assessment should include appropriate guideline-recommended laboratory tests (e.g., thyroid or vitamin B12 deficiency) as well as assessments for hearing loss, sleep apnea, depression, and side effects of medications. If reversible physiologic causes are ruled out, then proceeding with a diagnostic evaluation may be appropriate. 

“A diagnostic evaluation for dementia is intended to determine whether a person’s cognitive
impairment is caused by a neurodegenerative disease or another condition.”

A diagnostic evaluation for dementia is intended to determine whether a person’s cognitive impairment is caused by a neurodegenerative disease or another condition. Specific criteria for a diagnosis of dementia come from various sources. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) uses the term “neurocognitive disorder” rather than “dementia” (American Psychiatric Association, 2022).

The DSM-5-TR criteria for neurocognitive disorder require impairment in one or more of six cognitive domains:

  • Complex attention.
  • Executive function.
  • Learning and memory.
  • Language. 
  • Perceptual-motor. 
  • Social cognition. 

DSM Library

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The DSM-5-TR criteria require that the cognitive impairments must constitute a decline from a previous level of functioning, are serious enough to interfere with independent functioning, and do not occur solely in the course of delirium (American Psychiatric Association, 2022). Diagnostic criteria and codes for neurocognitive disorders along with links to the latest updates are available at the DSM Library.


Evaluate | Approaches to Implement

Diagnostic Overview | Explain the Importance of a Diagnostic Evaluation | Components of a Diagnostic Evaluation | Culturally Competent Approaches to Evaluations | Identify Conditions Underlying Dementia | Document the Diagnosis | Disclose the Diagnosis | Evaluate References